“We Don’t Need Your Help, But Will You Please Fix Our Children?” Australian and New Zealand Journal of Family Therapy (ANZJFT) Vol.29 No.2 pp. 61-69. 2008.

Jenny Brown. PhD

Excerpts

Without a systems view, problems in a child will be explained with linear cause and effect thinking. When parenting deficits are seen as primary contributors to a child’s symptoms, the tendency is to separate children from their parents to assist them in building resilience and to use psychoeducation to improve parent effectiveness. When biological deficits are viewed as causal in a child’s symptoms, the parents are viewed as requiring education about the nature and treatment of the illness. In a family systems framework, the child’s symptoms are seen as embedded in patterns of reactivity from all members of the family and in societal process (Bowen, 1974 &1975; Smith, 2001). Even when the symptoms have a biological basis, they are still viewed as being impacted by the degree to which the child is anxiously focused on and how the child responds in the reciprocal pattern that emerges (Kerr, 1988). An intense child focus, which can be positive or negative, presents significant developmental challenges to the young person as they come to function in reaction to others. This leaves them with little emotional breathing space to grow in thinking, feeling and acting for themselves (Donley, 2003; Maloni, 1998; Gilbert, 1999). This paper will draw from parents’ feedback in two cases in an effort to shed some light on the conditions that may facilitate a parent’s willingness to consider looking at their own contribution to the circular relationship patterns in which symptoms have emerged. The clients’ comments also provide insight into how the therapist can maintain a respectful engagement with parents who are distressed about their child’s symptoms, and also open up a broader systems exploration.

Even when parents and other family members are agreeing to attend the family therapy sessions, it is often difficult to shift the focus from discussing how to “fix” the problems of one child or sibling relationship. From a Bowen Family Systems perspective, a goal in therapy is to ask about how family members are responding to the presence of symptoms as opposed to what might be causing the problem. This aims to increase the parent’s focus on themselves in the system. It invites family members to more awareness of them self (differentiation) and their impact on others as well as their reactions to others in the system. The distinction of the actions and reactions of self in the web of relationships is seen as a preferable alternative to inviting a focus on others through family members expressing their views about how to change or blame others (Papero, 2000). The tightrope the therapist walks in this approach is how to ask questions that bring forth reflections about the impact of their own behaviours on the symptom bearer and others without taking on a “blame the parents” tone. It is quite understandable that parents, who are asking for help, are generally trying their best and would feel vulnerable to anything suggesting a shift in blame away from external factors or individual factors inherent to the child. For example if a therapist asks the parents to describe their own relationship without a clear connection to the presenting problem, this can readily “lead to a battle over what constitutes the real problem…… there may not be any readiness to address marital issues and the family may withdraw from therapy” (Nicholson, 1993:76). The therapist confronts a common dilemma of staying with the parents “fix the child” focus in order to engage them, versus expanding their view to consider their possible part in the child’s symptoms with the risk of them dropping out of therapy. On one side of the dilemma, the parents may feel relieved that a professional is willing to join them in their efforts to fix their child. On the flip side, the attention to the child’s difficulties may lay a heavy burden on the child for taking on the responsibility for change. It may also leave uncovered the underlying relational process that fuels the maintenance of problems; so that symptom relief is either short lived or the problem focus shifts to another member of the family.